Summer is coming! Why not grab a racquet and bring a couple friends to a tennis court to enjoy the sun and some Tennis. As one of the most popular sports in the world, tennis is played at different levels of skills from beginner to professional among both genders and all ages. However, similar to any other sports, tennis is no exception to injury; therefore, regardless of skill level, it is important to develop injury prevention strategies.
In Tennis, the most common injuries are seen in the lower body, followed by the upper extremities and finally the trunk [1, 2]. Acute injuries more commonly happen in the lower extremities, and ankle sprains and thigh strains are two of the most common acute injuries. In comparison, chronic injuries, such as low back pain, rotator cuff conditions, and elbow epicondylitis (Tennis Elbow), are seen more commonly in the upper extremities and trunk. This article will address each of these injuries in detail below.
Common Upper Extremity Injuries in Tennis
Shoulder injuries in tennis typically happen in the dominant shoulder, and the repetitive overhead motion on the serve likely plays an important role in the pathomechanics of the shoulder. Although shoulder injuries in the nondominant shoulder is not common, it does happen sometimes and could be related to the two-hand backhand or service toss.
Most shoulder injuries are overuse in nature and they include rotator cuff and biceps tendinosis (unlike tendonitis, tendinosis is degeneration of tendon tissue, tendonitis is tendon pain caused by inflammation) and tear, shoulder impingement,, labral tears, and shoulder osteoarthritis. One of the major contributions to shoulder injuries could be the atrophy of the external rotator cuff muscle as studies have found visual external rotator cuff muscle atrophy and external rotation weakness among professional tennis players at pre-participation physicals [3, 4].
Similar to shoulder injuries, elbow injuries are common in the dominant arm. Elbow injuries such as lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow) are very common in recreational players and advanced players respectively. Tennis elbow is often associated with eccentric load on the one-handed backhand stroke. Golfer’s elbow is typically associated with the serve and forehand. Contributing factors to elbow injuries include stroke technique, racquet characteristics, string material and tension, and grip size.
Unlike both shoulder and elbow injuries, wrist injuries are common in both the dominant and nondominant extremities. Tendinopathy of both the flexor and extensor tendons at the wrist is a common complaint of wrist discomfort. On the ulnar (pinky) side of the wrist, structural injuries are more common and typically involve tears of either the triangular fibrocartilage complex (TFCC) or the extensor carpi ulnaris (ECU) tendon or subsheath. Racquet grip style is also a major contribution factor to wrist injuries as radial (thumb) sided injuries are associated with the eastern grip, and ulnar (pinky) sided injuries are associated with western and semi-western grips [5].
Common Lower Extremity Injuries
Similar to other sports, lower extremity injuries in tennis represent a spectrum of conditions presenting alone or in combination, including adductor, abductor and hip flexor muscle strains, athletic pubalgia, osteitis pubis, acetabular labral tears, and femoroacetabular impingement (FAI). Because of the start-stop nature of the game, requiring explosive movements and frequent changes of direction , it provides a mechanism for eccentric overload of the lower extremity musculature. As a result, quadriceps, hamstring, and adductor strains are common in tennis players at all levels. One thing to point out is that many above mentioned injuries could be the manifestation of FAI. FAI is a motion-related clinical condition of the hip involving premature contact between the acetabulum and the proximal femur. It may be related to the more common use of the open stance forehand and backhand in today’s game.
Knee is another frequently injured joint in tennis and patellar tendinosis (jumper’s knee) is one of the most common knee pathologies among tennis players. This particular injury is generally related to repetitive eccentric overloading. On the other hand, quadriceps tendinosis is less common in tennis players. Another common knee injury is medial collateral ligament (MCL) injury.
Among all the lower extremity injuries, ankle sprains are the most common acute injury. Lower leg injury such as Tennis leg - mid calf pain is also a common tennis injury involving the medial head of the gastrocnemius. Achilles tendinopathy is also quite common. Depending on the court surface, plantar fasciitis is another common problem among tennis players.
Injuries on the ATP World Tour
Just for fun, the table below shows the most common diagnoses per anatomical area from 2014-2016 among ATP World Tour Professional Tennis Players.
RegionMost common diagnosis (%) of region categoryFoot/ankleAnterior talofibular ligament sprainThighHamstring 2013 → Adductor 2014 → Quadriceps 2015ElbowMedial epicondylitisShoulderRotator cuff tendonitis/impingementKnee Patellar tendinopathyHipFemoroacetabular impingement
Court Surface Affect Tennis Injuries
Tennis injury can be affected by court surface characteristics as tennis typically is played on a variety of surfaces. There is no significant difference in the overall prevalence of lower limb injury on clay, hard court, sand-filled artificial grass, and re-sand-filled artificial grass, but there is a higher prevalence of lower limb overuse injuries on hard court compared to other court surfaces. In addition, playing on multiple surfaces had a higher injury chance, particularly of overuse injuries than only playing on one course surface.
Tennis is a lifelong sport. Although it is a noncontact individual sport, injuries are not uncommon, but avoidable. In this Tennis injury article, we addressed the most common injuries in Tennis. In our next article, we will provide injury prevention strategies and programs to help you keep on playing. But in the meantime here are some exercises that may help with the most common injuries.
Banded External Rotation 2x15 ea
Wrist Flexion and Extension Stretch 2x 45s hold ea
Banded Lateral Step 2x10 ea
Single Leg Balance 2x45s ea
Half Kneeling Hip Flexor Stretch 2x15 ea
References:
Pluim BM, Staal JB, Windler GE, Jayanthi N. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40(5):415–23.
Lynall RC, Kerr ZY, Djoko A, Pluim BM, Hainline B, Dompier TP. Epidemiology of National Collegiate Athletic Association men’s and women’s tennis injuries, 2009/2010–2014/2015. Br J Sports Med. 2016;50(19):1211–6.
Young SW, Dakic J, Stroia K, Nguyen ML, Harris AH, Safran MR. High incidence of infraspinatus mus- cle atrophy in elite professional female tennis players. Am J Sports Med. 2015;43(8):1989–93.
Ellenbecker TS, Dines D, Renstrom P, Windler G. Visual observation of apparent infraspinatus muscle atrophy in professional male tennis players. J Orthop Sports Phys Ther. 2018;48(1):A38.
Tagliafico AS, Ameri P, Michaud J, Derchi LE, Sormani MP, Martinoli C. Wrist injuries in nonpro- fessional tennis players: relationships with different grips. Am J Sports Med. 2009;37(4):760–7.
*LabMotus has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.